[Day/Night Variability of Coughing Events in Interstitial Lung Disease]. / Tag-/Nachtvariabilität von Hustenereignissen bei interstitiellen Lungenerkrankungen.

INTRODUCTION: Besides dyspnea a dry cough is one of the main symptoms in patients with pulmonary fibrosis. Little is known about the 24-hour-variability of this symptom. Moreover, it is unclear if other auscultation phenomena occur. METHODS: A long-term auscultation for 24-hours was performed in patients with fibrotic lung diseases (LEOSound, Löwenstein Medical GmbH & Co. KG, Medical-Electronics, Bad Ems, Germany). Coughing and wheezing sounds were recorded. For the following analysis the 24-hour period was divided into two intervals of 12 hours each (daytime and nighttime). Events were registered in epochs (at least one event in 30 seconds). RESULTS: 20 patients were included (6 with nonspecific interstitial pneumonia and 14 with idiopathic pulmonary fibrosis). On average 166 coughing epochs were recorded in a 24-hour-period (day/night 116/50; P < 0.001). Moreover, 203 wheezing epochs were registered (day/night 84/119; P = 0.273). Auscultation phenomena did not correlate with spirometric and bodyplethymographic data, nor with data of diffusion capacity. DISCUSSION: The study is showing the clinical potential of long-term auscultation in patients with fibrotic lung diseases. Especially the findings concerning the coughing symptoms were remarkable. It could be shown that there was a decrease of coughing during nighttime in comparison to daytime. In contrast to this, wheezing sounds were increasing at nighttime. The clinical relevance of this finding is yet to be assessed. Finally, there was no correlation between the severity of the disease measured by functional diagnostics and the amount of coughing.

[Regional distribution of the cochlear implant (CI) centers in Germany]. / Regionale Verteilung der Cochlea-Implantat (CI)-versorgenden Einrichtungen in Deutschland.

The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).

[Acute Eosinophilic Pneumonia (AEP) after Hookah Smoking]. / Akute eosinophile Pneumonie (AEP) nach Shisha-Rauchen.

A 27-year-old, previously physically healthy man presented to an emergency department with an acute onset of thoracic pain, dyspnea, non-productive cough and fever. Hours before the onset of symptoms, the patient has smoked tobacco using a waterpipe (spearmint taste, not commercially available in Germany). Due to a progressive respiratory failure the patient required invasive mechanical ventilation. The computertomography scan of the chest showed bilateral diffuse, infiltrative changes. The diagnosis of hookah smoking associated Acute Eosinophilic Pneumonia (AEP) was based on the patient's history, the eosinophilic count in broncho-alveolar lavage and the computertomographic findings. After treatment with corticosteroids, the patient could be extubated after 9 days. The outpatient follow-up revealed a normal lung function testing and X-ray of the chest without any physical sequelae. CONCLUSION: In cases of acute onset of thoracic pain, dyspnea, non-productive cough and fever, acute eosinophilic pneumonia should be considered for differential diagnosis in association with shisha smoking. Severe respiratory lung failure can be successfully treated with corticosteroid therapy and ventilation resulting in full recovery.

[Real-time optical coherence tomography-assisted high-precision vitreoretinal surgery in the clinical routine]. / Echtzeit-optische Kohärenztomographie-assistierte Hochpräzisionsvitreoretinalchirurgie in der klinischen Routine.

The complete integration of spectral domain optical coherence tomography (SD-OCT) into an operating microscope now enables targeted, high-resolution imaging-guided vitreoretinal surgery. This provides real-time visualization of retinal layers, vitreous body and instrument-tissue interactions, which can be used for intraoperative decision making. Compared to conventional surgical microscopes, intraoperative OCT enables a greatly enhanced precision of vitreoretinal surgical maneuvers and is an essential prerequisite for the implementation of real-time guided surgical techniques at the micrometer level.

Low and disparate seroprotection after pentavalent childhood vaccination in the Lao People's Democratic Republic: a cross-sectional study.

OBJECTIVE: In Lao People's Democratic Republic, the high burden of vaccine-preventable diseases is thought to be mainly due to low vaccine coverage. We investigated the seroprotective response against diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (DTPw-HepB-Hib) vaccine in children. METHODS: Serum was collected from 1131 children aged 9 to 50 months and their mothers in a cross-sectional study between December 2013 and July 2014. All children had records of three injections of the DTPw-HepB-Hib vaccine. Serum was analysed for hepatitis B surface antigen (HBsAg), anti-HBsAg (anti-HBs), anti-hepatitis B virus core antigen (anti-HBc), anti-diphtheria and anti-tetanus antibodies. Stool samples were collected for detection of parasites. Demographic and nutritional information were also obtained. RESULTS: Protective levels of anti-HBs antibodies were found in 394 (37.9%) of 1039 children; 529 (55.7%) of 950 and 809 (85.2%) of 950 children were seroprotected against diphtheria and tetanus. Time since vaccination, age, home birth and malnutrition only partially explained the poor vaccine responses. Overall, 81 (7.8%) of 1039 children and 445 (40.3%) of 1105 of mothers were anti-HBc positive. Ten (1.0%) of 1039 of the children and 77 (7.0%) of 1105 of the mothers were HBsAg carriers. CONCLUSIONS: After a full documented course of vaccination, seroprotective rates were unusually low and disparate against components of the pentavalent vaccine. These can only partially be explained by the negative predictors identified. Although many children had been infected, only few were chronic carriers of HBsAg. Our study demonstrates an urgent need to monitor the serologic response to vaccination, particularly in resource-poor countries.

Post-invasion events after infection with Staphylococcus aureus are strongly dependent on both the host cell type and the infecting S. aureus strain.

Host cell invasion is a major feature of Staphylococcus aureus and contributes to infection development. The intracellular metabolically active bacteria can induce host cell activation and death but they can also persist for long time periods. In this study a comparative analysis was performed of different well-characterized S. aureus strains in their interaction with a variety of host cell types. Staphylococcus aureus (strains 6850, USA300, LS1, SH1000, Cowan1) invasion was compared in different human cell types (epithelial and endothelial cells, keratinocytes, fibroblasts, osteoblasts). The number of intracellular bacteria was determined, cell inflammation was investigated, as well as cell death and phagosomal escape of bacteria. To explain strain-dependent differences in the secretome, a proteomic approach was used. Barrier cells took up high amounts of bacteria and were killed by aggressive strains. These strains expressed high levels of toxins, and possessed the ability to escape from phagolysosomes. Osteoblasts and keratinocytes ingested less bacteria, and were not killed, even though the primary osteoblasts were strongly activated by S. aureus. In all cell types S. aureus was able to persist. Strong differences in uptake, cytotoxicity, and inflammatory response were observed between primary cells and their corresponding cell lines, demonstrating that cell lines reflect only partially the functions and physiology of primary cells. This study provides a contribution for a better understanding of the pathomechanisms of S. aureus infections. The proteomic data provide important basic knowledge on strains commonly used in the analysis of S. aureus-host cell interaction.

[Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases]. / Le tétanos à Hô-Chi-Minh-Ville, Vietnam : épidémiologie, clinique et pronostic, à propos de 389 cas à l'Hôpital des maladies tropicales.

The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p < 0.001], sepsis (24%) [OR = 3.25; (p < 0,114], and acute renal failure (16%) [OR = 7,22; p < 0.004]. Age over 60-year [OR = 4.53; p < 0.0001] and a leukocyte count>12.000/mm(3) [OR = 2.32; p < 0.020] were significantly associated with fatal outcome, contrarily to incubation and extension phase durations, or delayed serum administration. Systematic extension of vaccination to all adult males, and improved access to post exposure sero-immunization at all levels of health centres throughout the country may further reduce tetanus burden in Vietnam.

[Diabetes among new cases of pulmonary tuberculosis in Hanoï, Vietnam]. / Diabète chez les nouveaux cas de tuberculose pulmonaire à Hanoï, Vietnam.

The aim of this study was to analyze all new pulmonary tuberculosis cases and to assess the frequency and consequences of associated diabetes mellitus. Although apparently distinct, these two diseases could be linked, as suspected since decades. The context is the persistent endemicity of tuberculosis and the recent emergence of diabetes, two major health events for developing countries. The study was conducted at National TB hospital in Hanoï, Vietnam, and retrospectively included tuberculosis patients, cases with diabetes and controls without diabetes, collected during a three-year period 2006-2008. Cases associated with HIV infection or other comorbidities potentially affecting mortality were excluded. Among 2867 new pulmonary TB cases, 254 (8.8%) had associated diabetes. Eighty-six cases and 86 matched controls were included. Among cases mean blood glucose at admission was 14.4 mmol/dl, and patients were mostly urban (50% cases vs 32.5% controls, p=0.03). Clinical symptoms were similar in both groups. However, chest X-Ray cavitary images were significantly more frequent among cases (38.3% vs 16.3%, p=0.002, OR=4.1), as did infiltrative images (78% vs 62%, p=0.017, OR=2.55) and positive sputum smears (67.4% vs 47.8%, p=0.014, OR=2.21). In Vietnam, DM is found in quasi 9% of patients with a new diagnosis of primary pulmonary TB. The diabetes-TB patients may have more severe radiologic findings and a higher smear positivity rate. We suggest that in addition to the systematic HIV screening, all new TB patients should also be screened for diabetes.

Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death.

OBJECTIVES: The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam. METHODS: A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009. RESULTS: Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR=52.2, P<0.001); (ii) patients having received only secondary prophylaxis (OR=21.2, P<0.001); (iii) patients coinfected by hepatitis C (OR=2.3, P=0.02) and tuberculosis (OR=1.97, P=0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed. CONCLUSIONS: Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases.

[Acceptability of vaccination against human papillomavirus (HPV) by pediatricians, mothers and young women in Ho Chi Minh City, Vietnam]. / Acceptabilité de la vaccination contre les papillomavirus humains (HPV) par les pédiatres, les mères et les jeunes femmes à Hô Chi Minh Ville, Vietnam.

BACKGROUND: Cervical cancer (CC) is almost always induced by some oncogenic types of human papillomavirus (HPV). In Vietnam, it is the first leading cause of cancer in women, with highest prevalence in Ho Chi Minh City (HCMC). Since 2006, prevention of the CC has been improved by licensure of recombinant vaccines directed against HPV 16 and 18, effective when administered before the age of first sexual intercourse. A national program for routine immunization of pre-adolescent girls in addition to cytological screening of adult women would greatly reduce the impact of CC in Vietnam but vaccines remain expensive and it is unclear how this strategy would be accepted by the target population. The aim of this study was to assess the acceptability of HPV vaccination by pediatricians, mothers with a daughter aged 9-15 years and young women aged 16-26 years in HCMC. METHODS: Between March and June 2010, a cross-sectional survey of knowledge and attitudes was administered to 115 pediatricians in the pediatric hospital, 210 mothers and 400 young women attending the gynecology department of the University Hospital. RESULTS: Pediatricians generally had a good perception of the risk but they still lacked knowledge about HPV vaccination, given by 66% of them. Among mothers, 18% knew the relationship between HPV infection and CC, 43% had heard of HPV vaccination and 40% agreed to vaccinate their daughter. Among young women, 35% knew the risk, 49% knew the vaccine and 38% wanted to be vaccinated. Level of education, amount of income and celibacy were positively related to intention to be vaccinated. The lack of information on HPV vaccination and the high cost of vaccines were the main causes of refusal or indecision. CONCLUSION: Routine HPV vaccination of girls in HCMC will be well accepted by the population if a large campaign of health education is implemented by the government and if the affordability of vaccines is facilitated.

[Outcome 4 years after isolated single-bundle posterior cruciate ligament reconstruction]. / Vierjahresergebnisse nach Isolierter Hinterer Kreuzbandrekonstruktion in Einbündeltechnik.

BACKGROUND: The purpose of this study was to evaluate the clinical and radiological results after isolated reconstruction of the posterior cruciate ligament (PCL) using semitendinosus (ST) and gracilis (GT) tendon grafts with the arthroscopic single-bundle technique. MATERIALS AND METHODS: Following PCL reconstruction using the single-bundle technique performed between 2002 and 2005, 14 patients (2 women, 12 men) prospectively underwent a standardized follow-up examination after an average postoperative time of 4 years. All patients included in this study had isolated insufficiency of the PCL and symptomatic instability. The exclusion criteria were the presence of a complex knee joint instability and the implementation of additional stabilizing measures or another method of PCL reconstructive surgery. The mean follow-up time was 47.2 ± 8.7 months. Preoperative and postoperative stress radiographs were taken using the Telos stress instrument in order to evaluate the posterior translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective IKDC score and the overall IKDC score. RESULTS: The posterior tibial translation of 10.1 ± 1.7 mm had an overall average improvement to a postoperative value of 4.6 ± 2.3 mm (p < 0.001). The patients showed a significant improvement in the Tegner activity score from an average 2.7 ± 0.8 points to 5.7 ± 1.3 points (p < 0.001). Evaluation of the subjective IKDC showed a significant improvement from a preoperative score of 41.32 ± 11.23 points to a postoperative score of 65.08 ± 13.51 points (p < 0.001). In total, 10 patients (71.5%) exhibited a normal or nearly normal outcome. According to the objective IKDC score, 4 patients (28.5%) were categorized as moderate. CONCLUSION: The above mentioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers a medium-term improvement regarding the activity level and stability of the knee joint.

Structural properties of a new device for graft fixation in cruciate ligament reconstruction: the shim technique.

INTRODUCTION: In ACL reconstruction using a soft tissue graft, aperture fixation with interference screws (IFS) can lacerate and rotate the graft and cause primary tunnel widening. To overcome these downsides, a new wedge-shaped implant (MegaShim, Karl Storz, Germany) was developed. We hypothesized that aperture fixation of hamstring ACL reconstruction using the MegaShim technique shows comparable structural properties when compared to interference screw fixation. METHODS: In a porcine knee model, ACL reconstructions with a tunnel diameter of 6, 7, 8 and 9 mm were performed and human hamstring grafts were fixed using the MegaShim technique (group I). In group 2, grafts were fixed in a hybrid fixation using a MegaShim and cortical flip button (FlippTack, Karl Storz, Germany). Interference screw graft fixation served as a control group (group III). Maximum load, yield load and stiffness were recorded using material testing machine. Grafts were cyclically preconditioned between 0 and 20 N for 10 cycles before the graft-bone complex was loaded to failure. Statistical evaluation was performed using SPSS Version 11.0. RESULTS: Mean maximum load to failure for the hybrid fixation was significantly higher than after interference screw or MegaShim fixation. The difference between MegaShim and interference screw fixation showed no significant difference for 6 and 7 mm sizes. An 8 and 9 mm MegaShim fixation resulted in significantly lower ultimate failure load compared to interference screw fixation. Stiffness of grafts fixed using 6 mm MegaShim was significantly lower than grafts fixed with hybrid or interference screw fixation, whereas no significant differences were found in the 7, 8, and 9 mm fixations. CONCLUSION: Aperture fixation using the MegaShim technique provides comparable structural properties compared to interference screw fixation. Hybrid fixation using MegaShim and cortical flip button results in significantly higher ultimate failure loads than both aperture fixation approaches. Smaller grafts (6 mm) showed significantly lower ultimate failure load and stiffness than interference screw fixation. The "MegaShim technique" is an alternative to interference screw fixation concerning initial fixation strength.

[Bacterial flora in acute exacerbations of chronic obstructive pulmonary disease (COPD) in Kunming, China]. / Flore bactérienne des exacerbations aiguës de bronchopneumopathie chronique obstructive (BPCO) à Kunming, Chine.

OBJECTIVE: Chinese recommendations for the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) include antibiotic treatments targeting the most frequently isolated pathogens according to the severity of COPD. The study objective was to check the relevance of these recommendations in Yunnan, a Southern Chinese province. PATIENTS AND METHODS: A descriptive and analytical survey was conducted in the Kunming Medical University hospital among patients over 60 years of age, hospitalized with AECOPD, between March 2007 and June 2008. RESULTS: The 74 included patients were predominantly male (90%), with a mean age of 78.6 years, active or ex-smokers (81%), mainly with moderate (43%) or severe COPD (34%). Out of 87 AECOPD episodes, 47 (54%) yielded significant quantitative sputum cultures for S. pneumoniae (10%), P. aeruginosa (10%), H. influenzae (7%), M. catarrhalis (7%), and K. pneumoniae (7%). The positivity of sputum cultures was significantly linked with a history of smoking (P=0.002). More than half of the P. aeruginosa isolates were multidrug resistant. CONCLUSIONS: The distribution of pathogens isolated from EABPCO in Kunming corroborates published results. It does not question Chinese recommendations for first-line antibiotic therapy, but the high prevalence of P. aeruginosa and Enterobacteriaceae requires a periodic screening for acquired antibiotic resistance.

[Penicilliosis in Vietnam: a series of 94 patients]. / La pénicilliose au Vietnam: une série de 94 cas.

PURPOSE: Haiphong is the second city of Vietnam most affected by HIV infection. Penicilliosis represents the third leading cause of opportunistic infection. However, this systemic fungal infection remains poorly knew by practitioners. This study aimed to clarify the clinical, diagnostic and therapeutic aspects of penicilliosis. METHODS: It is a descriptive study, prospective and retrospective, conducted over a 3-year period in Viet Tiep hospital, Haiphong. RESULTS: With 94 cases, penicilliosis represented 11% of opportunistic infections. The patients were young (mean: 33 years) and male (87%). The main symptoms were persistent fever (99%), weight loss (88%), skin lesions (86%), hepatomegaly (69%) and lymphadenopathy (68%). Anemia was noted in 77% of cases. The average CD4 count was 29/µL. The culture of skin biopsies and blood culture were positive for Penicillium marneffei in 94% and 90% of cases, respectively. Despite antiretroviral and antifungal therapy, the mortality rate was 18%. Itraconazole monotherapy, administered in 53 patients due to the unavailability of amphotericin B, did not significantly affect the survival compared to the recommended treatment received by the 41 other patients. CONCLUSION: In Haiphong, penicilliosis is one of the most frequent and severe opportunistic infections of AIDS. The diagnosis should be considered in all febrile and immunocompromised patients having spent time in Vietnam. The prognosis can be improved by early diagnosis through the blood culture and a good adherence to an appropriate antifungal therapy.

[Two outbreaks of eosinophilic meningitis in Yunann (China) clinical, epidemiological and therapeutical issues]. / Epidémies de méningite à éosinophiles au Yunnan (Chine): aspects épidémiologiques, cliniques et thérapeutiques.

Eosinophilic meningitis is an uncommon clinical entity, which is mostly caused by Angiostrongylus cantonensis, a nematode which parasitizes rat's lungs. Humans represent a dead-end in the parasite's lifecycle and become infected by ingesting snails, slugs or transport hosts. Due to uncontrolled proliferation and circulation of snails and rats, human angiostrongyliasis has emerged in new foci in continental China. The treatment, which relies upon a combination of albendazole and corticosteroids, is still a matter of debate. In order to assess the epidemiological features of two outbreaks which occurred in Kunming, capital of the Yunnan province, 2003 and 2005, along with the clinical and treatment issues, a retro-prospective study was carried out among thirty-four clinical cases of eosinophilic meningitis. Furthermore, a parasitological survey was carried out on randomized samples of snails sold in the markets of the city On admission, all cases were found to have acute headaches and an eosinophilic pleocytosis rate > 5% in the cerebro spinal fluid (CSF). All patients reported the consumption of raw snails Pomacea canaliculata, 14 days on average before the onset of headaches (range 1-30 days). Hyperesthesia due to radiculitis was observed in 68% of the cases and the meningitis syndrome was present in 41%. The average value of blood eosinophil count in CSF and in peripheral blood was 38% and 900/ml, respectively. Two treatment schedules were used (without randomization): one with progressive doses over 4 weeks; the other with immediate high doses for 10 days with 3 sessions separated by 14-day intervals. The results were compared by the Kaplan Meier log rank test. All the cases had a favorable evolution. The analysis suggested better effectiveness and tolerance of the albendazole - dexamethasone combination used at the highest dosage, namely 20mglkg daily and 10mg daily respectively. Eosinophilic meningitis appeared to be recently emerging or re-emerging in Kunming. Deep-rooted culinary habits of eating raw food, and large amount of snails sold on local markets (about one ton per day) provide ideal conditions for the outbreak, or occurrence of this disease. According to the resdjlts of this study Chinese local authorities should be urged to improve information to the population about the risks of eating raw snails, in order to strengthen the control of both rat and snail populations and reinforce the supervision of local food markets.

Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR.

BACKGROUND/OBJECTIVE: To assess the traditional postpartum practices, mother and child nutritional status and associated factors. SUBJECTS/METHODS: A cross-sectional study in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR (Laos). 300 pairs of infants (< 6 months of age) and their mothers were enrolled. Information was collected about pregnancy, delivery and traditional practices through a standardized questionnaire. Dietary intake and food frequency were estimated using the 24 h recall method, calibrated bowls and FAO food composition tables. Mothers' and infants' anthropometry was assessed and multivariate analysis performed. RESULTS: Contrasting with a high antenatal care attendance (91%) and delivery under health professional supervision (72%), a high prevalence of traditional practices was found, including exposure to hot beds of embers (97%), use of traditional herb tea as the only beverage (95%) and restricted diets (90%). Twenty-five mothers (8.3%) were underweight. Mothers had insufficient intake of calories (55.6%), lipids (67.4%), iron (92.0%), vitamins A (99.3%) and C (45%), thiamin (96.6%) and calcium (96.6%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3-39.8 days) complementary food by 53.7% of mothers, and was associated with stunting in 10% children (OR=1.35, 95% CI:1.04-1.75). CONCLUSION: The high prevalence of traditional postpartum restricted diets and practices, and inadequate maternal nutritional intake in urban Laos, suggest that antenatal care may be an important opportunity to improve postpartum diets.

Trichinellosis during pregnancy: a case control study in the Lao Peoples' Democratic Republic.

Transmission of Trichinella to humans is still a global public health concern. Although theoretically possible, vertical transmission of Trichinella has rarely been investigated. In June 2005 an outbreak of trichinellosis was reported in Udomxay province, the Northern Lao Peoples' Democratic Republic (PDR). In February and March 2006 we performed a study of all pregnant and lactating mothers and infants in the location of this outbreak to assess the possible occurrence of vertical transmission. The study used questionnaires, mother and child clinical examinations, and serology (Western blot) and, based on the results, women were classified as suspect, possible, or confirmed cases. A control group included unexposed pregnant women and their children. Among 200 women from 21 villages, 8 were confirmed positive for trichinellosis by serology; 4 of these were symptomatic. Among their children, one died in utero at 26 weeks gestation due to maternal hepatitis of unknown etiology and a second child had Trichinella-specific IgG antibodies but was clinically normal. A third child, with negative serology had an inter-ventricular cardiac communication. The remaining children did not differ from controls. Our results cannot prove that transmission of trichinellosis occurs from mother to child.